Ultimately, much of Red Dead Redemption 2 is about surviving relentless violence. As Arthur, you are the frequent arbiter of such violence, but you are often the recipient of it, too. As a member of the Van der Linde gang, Arthur Morgan attacks and defends himself against robbers, backwoods cannibals, bounty hunters, and enemy gangs.
Like most video games, Red Dead Redemption 2 includes healing: eating food, drinking certain items, or ingesting medicine will repair Arthur’s physical health. In this regard, Red Dead Redemption 2 aligns well with the history of the U.S. West: most folks on the mid-to-late nineteenth-century frontier utilized homeopathic medicine and home-crafted herbal medicine to solve a wide variety of ailments.
The rise of patent medicine at the turn of the twentieth century invades the game to some extent, as Arthur can both make his own medicine and buy similar products when he heads into town. The game admits that not everything is made equal: Kentucky Bourbon, cigarettes, moonshine, cocaine gum, and chewing tobacco may benefit Arthur in some ways but damage him in others. Notably, Red Dead Redemption 2 rarely includes opium or morphine, except for a few fleeting references, perhaps to avoid popularizing drug (ab)use during the current opioid crisis.
Red Dead Redemption 2 centers on one particular public health crisis: pulmonary tuberculosis. Also known as TB or consumption, tuberculosis is an infectious disease spread by transferring bacteria-ridden phlegm. Over a million people still die annually of tuberculosis today. In the nineteenth and twentieth centuries, the disease spread across the globe, affecting families, communities, and entire countries.
In the case of Arthur Morgan, the man that gives him tuberculosis is Thomas Downes, who he shakes down for money. By the time Arthur is showing the classic symptoms of tuberculosis — coughing up blood, high fever, weight loss, physical weakness — you’re late in the game’s plotline, but the screen doesn’t gently fade to black. Instead, Arthur collapses in the New Orleans-styled city of Saint Denis, coughing violently. After being brought to the city’s only physician, the doctor diagnoses him with tuberculosis, injects him with morphine, and says there’s nothing more to be done.
From this point forward in the game, you watch Arthur deteriorate: it’s the slow, gruesome tragedy of tuberculosis that the modern world still finds so appalling. Just like the historic reality of the American frontier, Arthur cannot be cured. Upon the game’s release, the Internet filled with panicked requests of “how do I cure Arthur??,” but his tuberculosis is an inevitable and integral part of the game. Like the thousands who struggled with the disease in the nineteenth century, Arthur has been handed a death sentence.